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Pain, Injury, Recovery and Sleep

Pain, Injury, Recovery and Sleep

If you are suffering with a chronic injury or pain lack of sleep may be the hidden piece of your recovery puzzle.


Lack of sleep leads to increased inflammation, increased pain and slowed healing – all of which are obviously disastrous when it comes to recovering from injury. Lets look at each in a little more detail…

Sleep is necessary, if not essential, for recovery from pain and disability

Okifuji, A

Sleep and Recovery

The tissues of the body are continuously broken down and rebuilt / renewed. Sleep is critical for healing as it shifts the balance in favour of building and renewal. In fact, when tissues have been damaged, the rate of healing is greatest during sleep, whatever time of day the injury occurred [2].

Sleep and Injury

Lack of sleep not only slows recovery but also increases injury risk in the first place. Adolescent athletes who sleep less than 8 hours per night (on average) were found to have 1.7 times greater risk of injury than those who sleep more than 8 hours [3].

This increased to over double the risk (2.3) when shorter sleep was coupled with an increased training intensity and volume [4]

And this makes perfect sense. If you are training hard (and breaking down your muscles, tendons, ligaments etc) but you are not sleeping adequately to allow them to recover its logical that the outcome will be injury. The same goes for recovery after injury. If you are not sleeping enough for the injured tissue to rebuild, recovery will be slow or non-existent.

Sleep and Pain

Not only does lack of sleep slow recovery but it also effects the pain we feel.

Sleep disruption has been found to reduce pressure pain thresholds by 24% the next day. Unsurprisingly, improved sleep has been shown to reduce pain. [5]

“Sleep appears to be a natural analgesic.”

Matthew Walker

How does lack of sleep effect injury risk and recovery? 

There are many different mechanisms at play but 2 key ones are sleeps effect on hormonal release and inflammation.

Sleep deprivation or restriction leads to a decrease in the “renewal” hormones (e.g. testosterone and growth factor) whilst increasing the “breakdown” hormones (e.g. glucocorticoids). [6]

Lack of sleep also promotes chronic inflammation. Chronic or systemic inflammation is the “persistent inflammatory state which promotes ongoing tissue damage”. [7,8]

This chronic and widespread inflammation is linked with a host of chronic diseases including diabetes, cancer and cardiovascular disease but also muscle and joint problems such as disc herniation, arthritis and tendonitis. [9] And the level of sleep deprivation doesn’t have to be severe to start having an effect.  For most people, not getting at least 6 hours of sleep over a 24-hour period can cause out cells to release thesame inflammatory chemicals that are released during infection or trauma. [10]


  1. Okifuji, A., Hare, BD. (2013) Sleep Deprivation and Pain. In: Sleep Deprivation and Disease. Springer. p 171-183
  2. Adam, K., & Oswald, I. (1984). Sleep helps healing. British medical journal (Clinical research ed.), 289(6456), 1400-1401.
  3. Milewski, M. D., Skaggs, D. L., Bishop, G. A., Pace, J. L., Ibrahim, D. A., Wren, T. A., & Barzdukas, A. (2014). Chronic lack of sleep is associated with increased sports injuries in adolescent athletes. Journal of Pediatric Orthopaedics, 34(2), 129-133.
  4. von Rosen, P., Frohm, A., Kottorp, A., Fridén, C., & Heijne, A. (2017). Multiple factors explain injury risk in adolescent elite athletes: Applying a biopsychosocial perspective. Scandinavian journal of medicine & science in sports, 27(12), 2059-2069.
  5. Lentz, M. J., Landis, C. A., Rothermel, J., & Shaver, J. L. (1999). Effects of selective slow wave sleep disruption on musculoskeletal pain and fatigue in middle aged women. The Journal of rheumatology, 26(7), 1586-1592
  6. Dattilo, M., Antunes, H.K.M., Medeiros, A. (2011) Sleep and muscle recovery. Medical Hypotheses, 77: 2, 220-222, 2011
  7. Mullington JM, Simpson NS, Meier-Ewert HK, Haak M: Sleep loss and inflammation. Best Prac Res Clin Endocrinol Metab 2010, 24:775–784.
  8. Motivala SJ: Sleep and inflammation. psychoneuroimmunology in the context of cardiovascular disease. Ann Behav Med 2011, 42:141–152.
  9. Seaman, D. R., & Palombo, A. D. (2014). An overview of the identification and management of the metabolic syndrome in chiropractic practice. Journal of chiropractic medicine, 13(3), 210-219.

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‘Pain, Injury, Recovery and Sleep’ was written by Steffen Toates. Steffen is a chiropractor at Dynamic Health Chiropractic in Jersey CI. For more information about Steffen click here.

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